Mariantonietta Savarese

Sleep disorders and the natural history of Parkinson's disease: the contribution of epidemiological studies.

BACKGROUND Sleep disorders (SD) are one of the most frequent non-motor manifestations of Parkinsons disease (PD). Recent studies showed that SD may precede the onset of PD. OBJECTIVES We reviewed current literature concerning 1) the incidence of PD among subjects with SD; and 2) the occurrence and possible clinical correlations of SD during the course of PD. METHODS A Medline search found 17 longitudinal studies. RESULTS The incidence of PD among patients with rapid eye-movement sleep behavioural disorders ranged from 20% to 65% of cases, within a wide interval of time (range: 2.2-13.3). The incidence of SD during PD progressively increased with disease duration in population-based studies but presented marked fluctuations in clinical based studies. Older age, male gender, dopaminergic treatment with higher dosage, cognitive impairment and hallucinations were associated with the onset of SD during PD. In the only population-based study among Japanese men excessive daytime sleepiness was associated with a threefold increased risk of developing PD. CONCLUSIONS Available data suggest that SD could be the heralding clinical manifestation or a risk factor for PD onset. The prevalence of SD increases during the course of the PD and may be related to specific phenotype and rapid progression of PD. However, the current data are limited because of limited sample size and poor study design; prospective studies with larger sample size are warranted.

EEG features in juvenile migraine: topographic analysis of spontaneous and visual evoked brain electrical activity: a comparison with adult migraine.

Topographic analysis of spontaneous and steady-state visual evoked brain electrical activity was carried out between attacks in 82 migraine patients (40 youths and 42 adults). In adult migraine with aura a significant increase of delta rhythm percentage power was observed compared with migraine without aura and age-matched controls. Children suffering from migraine both with aura and without aura had an increased theta rhythm compared to normal controls. The presence of alpha interhemispheric asymmetry discriminated between migraine with aura and without aura, just as in adults. An increased amplitude of the SVEP F1 component with a tendency to the spread of visual reactivity was observed in juvenile migraine with and without aura; this pattern was not dissimilar from the one previously observed in adult migraine with and without aura. Abnormal photic driving in migraine is independent of age and type of migraine.

The importance of anxiety and depression as factors in chronicization of primary headaches

Abstract A multicenter study was carried out in 10 Italian headache centers to investigate the prevalence of anxiety and depression in patients with chronic daily headache(CDH). The study investigated 219 patients (171 F; 48 M) including 53 cases of chronic tension-type headache (CTTH), 99 cases of CTTH+ migraine and 67 cases of transformed migraine (TM). The type of headache diagnosed at the beginning was episodic tension-type headache (ETTH, n=32), ETTH + migraine (n=2), CDH ab initio (n=22), migraine with/without aura (n=151), not classifiable migraine (n=7) and not classifiable headache (n=3). The assessment of anxiety and depression was carried out using a Zung self-rating scale for anxiety (Zung A) and for depression (Zung D). The results show that anxiety and depression levels, in each group, were related to sex (F>M). Anxiety, but not depression, was related to the length of chronicization process. Anxiety and depression did not correlate with type of headache at onset, with ongoing headache or, surprisingly, with the abuse of anti-inflammatory drugs. These data suggest the chronicization is a biological and psychological trait.

Insomnia in general practice : a consensus report produced by sleep specialists and primary-care physicians in Italy.

Insomnia is an extremely common condition with major social and economic consequences worldwide. Two large epidemiological studies (Morfeo 1 and Morfeo 2) recently performed in Italy provided much-needed novel data on the impact of insomnia in patients whose primary healthcare is provided by general practitioners (GPs). These studies found that insomnia is managed relatively well by GPs in Italy, although diagnosis and treatment can be compromised because of the lack of standardised criteria. Although a number of consensus reports on insomnia have been published, these are mainly highly specific documents that are difficult to implement in general practice. To address this, a consensus group involving 695 GPs and over 60 specialists from the Italian Association of Sleep Medicine was established. The major objectives of the consensus study were to establish basic knowledge for the diagnosis and treatment of insomnia, and to produce guidelines for the management of insomnia by GPs. This is the first time that GPs have been directly involved in producing insomnia guidelines of this type, and this approach reflects their pivotal role in the diagnosis and management of this condition. Participants were carefully selected to ensure adequate representation of sleep specialists and GPs, with the group being headed by a steering committee and an advisory board. Guideline statements were selected following careful literature review and were voted on using formalised consensus procedures. This review describes current views on the diagnosis and management of insomnia from the perspective of the GP. In addition, the results of the consensus study are presented. They include recognition of the following principles: (i) insomnia is a genuine pathology that must be appropriately diagnosed and treated; (ii) when concomitant pathologies are present, additional significance should be given to treatment of insomnia since it can influence prognosis of coexistent disorders; (iii) appropriate treatment should consider the cause of insomnia as well as the characteristics of available pharmacological agents; (iv) with regard to hypnotic drugs, preference should be given to medications with a short half-life in order to limit residual effects; (v) non-benzodiazepine hypnotics are preferred to classic benzodiazepines as they have higher selectivity and present a lower risk of undesirable effects; (vi) tablets are preferable to liquid preparations as they are less likely to lead to dependence and to overdosing by the patient; and (vi) once treatment has been initiated, insomnia patients should be carefully followed up. These statements provide much needed criteria for better management of insomnia by GPs in Italy.

Tertiary treatment for psychiatric comorbidity in headache patients

The presence of significant and confounding psychiatric comorbidity is greater in patients attending headache clinics than in headache patients from the general population. The frequent comorbidity of headache with generalized anxiety disorder can take advantage of the administration of benzodiazepines. With regard to depression–related headache, it’s wellknown that the antidepressive drugs can improve migraine as well as tension–type headache. Antiepileptic drugs give one more good opportunity. The recognition of a psychiatric comorbidity is mandatory for an accurate management of the patient beacause prevents the clinicians from using any drug that might be dangerous for a mysdiagnosed psychiatric disturbance and often permits to administer medications that can efficaciously control both headache and psychiatric disorders.

Memory functions in patients with chronic daily headache

Abstract Memory loss is a common complaint in headache sufferers. 71 patients, 50 women and 21 men, affected by chronic daily headache with different diagnoses at onset and at study entry underwent a test battery in order to evaluate both short- and long-term memory according to the different sensorial pathway of data acquirement. Statistical analysis of the results was performed using means of Spearmans correlation coefficients, analysis of variance, chi-square, Fishers test and Mann-Whitney U test. A percentage of patients, ranging from 2% to 56%, according to the different tests, showed a worse performance than normal subjects. The percentage of the subjects with memory difficulty was higher in women and in patients with migraine-type headache at onset, but was not different between overusers and nonoverusers of analgesics, nor among the different forms of present headache. A complex neurotransmitter disorder might account for impairment of both short- and long-term memory in headache patients.

Personality factors in chronic headache: evaluation with SCL-90R

Abstract The psychopathological approach is fundamental in the study of chronic headache because it integrates the diagnosis of a pathology in which the symptom (headache) is the disease itself hiding in itself the deep message to decode. The Symptom Check List 90R(SCL-90R) is a scale of general evaluation of current psychopathology which can be self-administered by the patient. The scales of SCL-90R are correlated with those of the Minnesota Multiphasic Personality Inventory. Moreover the former test has the advantage of being shorter and more pratical so it was chosen to be used in this study on chronic headache. The results showed that the psychopathological profile of chronic headache patient is rather impaired in all the dimensions and indices measured by the test. No difference was found in the occurrence of psychopathological symptoms either between analgesic abusers and nonabusers, or among the three subtypes of chronic headache.

Headache and sleep: clinical and therapeutical aspects

Sleep disorders and headache are frequently comorbid. Anatomical, biochemical and physiologic common features and pathways could explain the bidirectional influence between sleep disorders and headache. One of the troubles often encountered in the evaluation of the comorbidity between sleep and headache disorders is that patients referring to tertiary headache centres are mainly concerned about their pain and generally do not tend to spontaneously report their possible sleep problems. But when they are specifically asked, very interesting data do emerge. The comorbidity headache-insomnia offers clinicians the opportunity to choose drugs able to control both disorders, avoiding molecules which could make insomnia worse while improving headache. A polysomnographic recording should be performed when a sleep apnoea headache is suspected and if diagnosis is confirmed, headache therapy should consist of the therapy of sleep apnoea itself. Morning headache in patients with periodic limb movements disorder during sleep is not responsive to standard headache therapy but needs to be treated with specific dopamine agonists which improve headache while relieving nocturnal movements.